: Increasingly, patients are faced with decisions that have many options, uncertain outcomes, and benefits and harms that are valued differently by each individual. Shared decision-making (SDM) recognizes the importance of having patients and providers work together to select tests and treatments. Patients and providers bring different expertise to the decision. Providers are mainly responsible for assimilating and appropriately applying evidence-based information and patients are responsible for sharing their preferences. Using SDM, well informed patients and providers can determine which choice matches what is most important to patients - delivering high quality care that is both evidence-based and patient-centered. In 2009, the bi-annual International Shared Decision Making (ISDM) conference will be held in the United States for the first time. The conference builds on the accomplishments of the four previous ISDM conferences held in Oxford, UK (2001), Swansea, UK (2003), Ottawa, CA (2005), and Freiburg, GR (2007). This scientific conference will be structured around oral presentation sessions, symposia, workshops, poster sessions, as well as an exhibition of decision support materials. The exhibition will create the opportunity to showcase decision support materials from around the world, allowing research groups to share their work in the form of informational booklets, training manuals, and interactive audio-visual materials. This conference will bring leading scientists, clinicians, policy makers, and payers together to learn, discuss, and debate key issues about the ways in which to best translate and implement SDM research into clinical practice. The ultimate purpose is to improve the decision-making capabilities of patients and to foster evidence-based, informed, patient-centered medical care. The specific aims are: 1) To identify and present the most promising conceptual frameworks, system requirements, methodological strategies, and outcome measures required for implementing SDM and patient decision aids (PtDAs) into clinical practice with particular emphasis on: a) Underserved populations (low literacy, low numeracy, low income, non-English speaking, rural patients, inner-city patients);b) Patients with chronic conditions;and c) Cross-cultural adaptation and dissemination of PtDAs and SDM. 2) To examine the regulatory, legal, and payment policies required to accelerate the wide-spread adoption of SDM and PtDAs into clinical practice. 3) To identify the best ways to measure the effect of SDM on the quality of decisions and the implications for the quality and costs of care.